GuidelineASGE guideline: colorectal cancer screening and surveillance
Introduction
Colorectal cancer (CRC) is the fourth most commonly diagnosed cancer and the second leading cause of cancer-related deaths in the United States.2 Each year, approximately 140,000 individuals are diagnosed with CRC and more than 50,000 will die from this malignancy.2 The 5-year survival rate for early-stage cancers is greater than 90%, whereas the 5-year survival rate for those diagnosed with widespread cancer is less than 10%.3 There is indirect evidence that most cancers develop from adenomatous polyps and that on average it takes 10 years for a <1 cm polyp to transform into invasive CRC.4, 5 Given the finding that adenomatous polyps are precursors to cancer and that polyps and early cancers are usually asymptomatic, there is a strong rationale to support screening asymptomatic individuals for early cancer detection and prevention.
Section snippets
Risk stratification
Approximately 30% of individuals harbor risk factors for CRC.6 These risk factors include family or personal history of CRC or adenomatous polyps, personal history of inflammatory bowel disease, and familial polyposis syndromes (including familial adenomatous polyposis [FAP] and hereditary nonpolyposis colon cancer [HNPCC]). The other 70% of individuals are considered average risk.
Personal history of inflammatory bowel disease
Individuals with long-standing ulcerative colitis (UC) and extensive Crohn's colitis are at increased risk for development of dysplasia and CRC, and they should undergo colonoscopic surveillance. The risk of CRC increases with the duration and extent of colitis, family history of CRC, continuing active colitis, young age at onset of disease, presence of backwash ileitis, and personal history of primary sclerosing cholangitis.96, 97, 98, 99, 100 The presence of proctitis alone does not appear to
Management of colonic polyps during flexible sigmoidoscopy
The decision to perform colonoscopy after the detection of a small adenoma on flexible sigmoidoscopy is controversial and should be individualized.40 Colonoscopy is the preferred method of examination of the colon after a flexible sigmoidoscopy with at least one adenoma found because it allows both the detection and removal of synchronous polyps. Controversy remains regarding whether individuals with small tubular adenomas (<1 cm) should undergo colonoscopy.120, 121 Factors associated with an
Management of colon polyps during colonoscopy
Most polyps seen during colonoscopy can be completely removed. The safety of polypectomy has been substantiated by the low incidence of complications reported in numerous series.25 The endoscopist should be prepared to perform a total examination and remove all polyps found at the time of the first colonoscopy, although technical factors encountered during colonoscopy may limit completion of the procedure. Every effort should be made to avoid repetitive procedures. Although controversy still
Summary
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Colonoscopy is the preferred modality for CRC screening in average risk patients (B).
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Alternative methods for CRC screening in average-risk patients include yearly fecal occult blood testing (A), flexible sigmoidoscopy every 5 years, combined yearly FOBT and flexible sigmoidoscopy every 5 years (B).
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Single digital rectal examination FOBT has a poor sensitivity for CRC and should not be performed as a primary screening method (A).
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Studies evaluating virtual colonoscopy and fecal DNA testing for CRC
References (129)
- et al.
Natural history of untreated colonic polyps
Gastroenterology
(1987) The evolution of colorectal carcinoma
Clin Radiol
(1984)- et al.
Colorectal cancer screening: clinical guidelines and rationale
Gastroenterology
(1997) - et al.
Randomised study of screening for colorectal cancer with faecal-occult-blood test
Lancet
(1996) - et al.
Randomised controlled trial of faecal-occult-blood screening for colorectal cancer
Lancet
(1996) - et al.
Prospective determination of distal colon findings in average-risk patients with proximal colon cancer
Gastrointest Endosc
(1999) - et al.
Screening and surveillance of colorectal cancer
Gastrointest Endosc Clin North Am
(2005) - et al.
Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies
Gastroenterology
(1997) Colonoscopic withdrawal technique is associated with adenoma miss rates
Gastrointest Endosc
(2000)- et al.
ASGE guideline: the role of endoscopy in the diagnosis, staging, and management of colorectal cancer
Gastrointest Endosc
(2005)
Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology
Am J Gastroenterol
A prospective multicenter evaluation of new fecal occult blood tests in patients undergoing colonoscopy
Am J Gastroenterol
U.S. Multisociety Task Force on Colorectal Cancer, colorectal cancer screening and surveillance: clinical guidelines and rationale—update based on new evidence
Gastroenterology
Prevention of colorectal cancer by once-only sigmoidoscopy
Lancet
The yield of a second screening flexible sigmoidoscopy in average-risk persons after one negative examination
Gastroenterology
The incidence of colorectal cancer following a negative screening sigmoidoscopy: implications for screening interval
Gastroenterology
Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison
Lancet
Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice
Gastroenterology
Virtual colonoscopy using oral contrast compared with colonoscopy for the detection of patients with colorectal polyps
Gastroenterology
Patient experience and preferences toward colon cancer screening: a comparison of virtual colonoscopy and conventional colonoscopy
Gastrointest Endosc
Is virtual colonoscopy a cost-effective option to screen for colorectal cancer?
Am J Gastroenterol
Colorectal neoplasia screening with virtual colonoscopy: when, at what cost, and with what national impact?
Clin Gastroenterol Hepatol
Colorectal cancer screening by detection of altered human DNA in stool: feasibility of a multitarget assay panel
Gastroenterology
Sensitivity and specificity of a stool DNA multitarget assay panel for the detection of advanced colorectal neoplasia
Clin Colorectal Cancer
Genotype-phenotype correlations in attenuated adenomatous polyposis coli
Am J Hum Genet
ASGE guideline: the role of endoscopy in the surveillance of premalignant conditions of the upper GI tract
Gastrointest Endosc
Endoscopic management of familial colonic neoplasia
Gastrointest Endosc Clin North Am
Efficient detection of hereditary nonpolyposis colorectal cancer gene carrier by screening for tumor microsatellite instability before germline genetic testing
Gastroenterology
A systematic review and meta-analysis of familial colorectal cancer risk
Am J Gastroenterol
Severity of inflammation is a risk factor of colorectal neoplasia in ulcerative colitis
Gastroenterology
Backwash ileitis is strongly associated with colorectal carcinoma in ulcerative colitis
Gastroenterology
Colorectal cancer screening and surveillance
Gastrointest Endosc
Cancer statistics
CA Cancer J Clin
Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging
J Natl Cancer Inst
Results of screening colonoscopy among persons 40 to 49 years of age
N Engl J Med
Screening for colorectal cancer
N Engl J Med
Prevention of colorectal cancer by colonoscopic polypectomy: the National Polyp Study Workgroup
N Engl J Med
Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence
Gut
Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I
Scand J Gastroenterol
Reducing mortality from colorectal cancer by screening for fecal occult blood: Minnesota Colon Cancer Control Study
N Engl J Med
Screening sigmoidoscopy and colorectal cancer mortality
J Natl Cancer Inst
A case-control study of screening sigmoidoscopy and mortality from colorectal cancer
N Engl J Med
Protection by endoscopy against death from colorectal cancer: a case-control study among veterans
Arch Intern Med
Long-term efficacy of sigmoidoscopy in the reduction of colorectal cancer incidence
J Natl Cancer Inst
Use of colonoscopy to screen symptomatic adults for colorectal cancer
N Engl J Med
Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings
N Engl J Med
Predicting advanced proximal colonic neoplasia with screening sigmoidoscopy
JAMA
Risk of perforation after colonoscopy and sigmoidoscopy: a population-based study
J Natl Cancer Inst
Standards of Practice Committee, American Society for Gastrointestinal Endoscopy: complications of colonoscopy
Gastrointest Endosc
Location of adenomas missed by optical colonoscopy
Ann Intern Med
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2023, Neoplasia (United States)Citation Excerpt :Despite this, CRC is often treatable with a high overall survival when detected and treated in its early stages [2]. This has led to the formation of global screening programs for CRC [3], which typically employ faecal biomarkers like the guaiac faecal occult blood test (gFOBT), followed by endoscopy [4]. The gFOBT, is a fast, noninvasive and inexpensive test, however, its diagnostic sensitivity ranges from 7 to 21% for the detection of early cancer (Stage 0 and I) and is unsuitable for the detection of complex adenomas [5,6].
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